Migraine

A migraine is not simply a severe headache, but a neurological event in which head pain may be only one part of the experience. Visual disturbance, nausea, sensory sensitivity, cognitive fog, and the need to withdraw into a dark, quiet room can be every bit as disabling as the pain itself.

It is also one of the conditions for which acupuncture has a strong evidentiary record of successful treatment. The Cochrane review of acupuncture for migraine prophylaxis found it reduces the frequency of attacks, that it outperforms sham needling, and that it performs at least as well as prophylactic drug treatment with markedly fewer side effects. The UK's national clinical guidance recommends a course of acupuncture for migraine prevention as a first-line option.

Chronic migraine — attacks on fifteen or more days a month — is a particular specialty of this practice, and has been for many years.

What we treat

• Episodic migraine, with or without aura
• Chronic migraine and chronic daily headache, including for those who have exhausted the preventive drug options
• Menstrual migraine — attacks tied to the cycle rather than the calendar, which respond to being treated as a gynecological problem as much as a neurological one
• Vestibular migraine and migraine with dizziness
• Migraine with prominent nausea
• Medication overuse headache — see below
• Migraine in pregnancy, where the preventive options are severely limited and acupuncture is one of very few things available
• Perimenopausal migraine, where attacks change or worsen with the hormonal transition
• Migraine with a cervical component, where neck dysfunction is a reliable trigger

How we work it out

There is no single migraine and there is no single protocol. We spend a substantial part of the first visit establishing the contours and characteristics of your case.

We ask where the pain is — the temples, behind the eye, the base of the skull, one side or both — and when it comes: on waking, at the end of the working day, at the weekend, before a period, after a particular food or a missed meal, in specific weather. We ask what it feels like — throbbing, pressing, boring, stabbing — and what comes with it: nausea, aura, photophobia, dizziness, a stiff neck. We ask what warns you it is coming, its severity, and what the aftermath is like.

In Chinese medicine these answers are diagnostic rather than descriptive. Pain at the temples and pain at the occiput belong to different channels and are treated at different points. A migraine that arrives with irritability and comes before a period is a different pattern from one that arrives with exhaustion after a long week, and the treatments are not similar.

What treatment involves

Preventive treatment is the objective. We treat weekly, usually for a course of eight to twelve sessions, and the measure is the headache diary rather than how you feel on the day.

Expect the changes in a particular order: attacks shorten and respond better to your acute medication first, severity eases next, and frequency — usually the last thing to move, and the one that matters most — follows after that. You may also notice the day-after fog lifting faster, which is worth as much as the attack itself easing.

Treatment during an attack is also possible and often very effective — if you can get here, come. You can also keep a standing option open for exactly this.

We use cupping and gua sha over the neck and shoulders too, where there is a cervical component, which there very often is. Herbs may come up for chronic and menstrual migraine in particular, if your practitioner thinks they're worth trying. Dietary and lifestyle work is specific rather than generic, and we ask you to keep a diary.

A successful course is usually followed by maintenance every three to six weeks. Migraine is a condition that is managed, and the maintenance is what keeps relapse at bay.

Medication overuse headache

If you have daily or near-daily headache, you may be in a medication overuse cycle — the acute treatment taken often enough to sustain the headache it is treating. Coming off it is the only route out, and it is unpleasant, with headaches worsening before they improve.

This is one of the situations where we are most useful, and where people most often succeed on a second attempt having failed alone. We treat frequently through the withdrawal period, working directly with the physician managing it. If you are taking acute medication on ten or more days a month, raise it at your first visit — nobody will judge you for it, and it changes the plan.

Working with neurology and the rest of your care

Neck dysfunction, TMJ, and bruxism are common contributors to migraine, and each is usually treated by a different kind of specialist.

Reducing acute medication as attacks become less frequent is a common outcome — a welcome one, and a conversation with your prescriber, not a goal we set for you.

Tell us everything you take, prescription and otherwise. Where herbs are part of your plan, they can interact with medication, so we need the full list either way. For migraine that most often means a preventive — a CGRP inhibitor, a beta blocker, topiramate, or amitriptyline — and treatment continues regardless of which one you're taking.

When to seek urgent medical attention

Go to an emergency department for a headache that comes on instantly and is the worst of your life, a headache with fever and a stiff neck, a headache with confusion, weakness, difficulty speaking, or visual loss, a headache after a head injury, or a headache that is new and severe if you are over fifty, pregnant, immunosuppressed, or have a cancer history.

New neurological symptoms during a migraine that are unlike your usual pattern should be assessed the same day.

Common questions

How long before I see fewer attacks?

Severity and duration usually improve first, often within three or four sessions. Frequency typically takes six to twelve weeks. Keep the diary — the change is easier to see on paper than in memory.

How many sessions?

Eight to twelve weekly for a preventive course, then maintenance every three to six weeks.

Can I come during an attack?

Yes, and it often helps considerably. If you can get here, come.

Do I have to stop my preventive medication?

No. Treatment continues whatever you are on. Any change is for your prescriber.

I take triptans most days.

Tell us at the first visit. That pattern is medication overuse headache and it is treatable.

Is it safe in pregnancy?

Yes, and it is one of very few preventive options available then. Tell us how many weeks you are.

My migraines are tied to my cycle.

Then they are treated as a gynecological issue as well as a neurological one, which is a specialty here. Bring cycle dates.

Does the neck matter?

Very often, yes. Where there is a cervical component we treat it directly with needling, cupping, and gua sha, and it can be the missing piece.